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Original Research

Open Access

An analysis of deviation from the ESGO quality indicators for surgical treatment of cervical cancer in a large referral center in the Netherlands

  • Constantijne H. Mom1
  • Luc R.C.W. van Lonkhuijzen1
  • Maaike C.G. Bleeker2,3
  • Guus Fons1
  • Jacobus van der Velden1,*,

1Department of Gynaecological Oncology, Amsterdam UMC, location University of Amsterdam, 1105 AZ Amsterdam, Netherlands

2Department of Pathology, Amsterdam UMC, location University of Amsterdam, 1105 AZ Amsterdam, Netherlands

3Department of Imaging and Biomarkers, Cancer Centre Amsterdam, 1105 AZ Amsterdam, Netherlands

DOI: 10.22514/ejgo.2023.107 Vol.44,Issue 6,December 2023 pp.128-135

Submitted: 09 May 2023 Accepted: 07 June 2023

Published: 15 December 2023

*Corresponding Author(s): Jacobus van der Velden E-mail:


Recently, the European Society of Gynaecological Oncology (ESGO) presented fifteen quality indicators (QIs) with the aim to improve quality of surgical treatment for cervical cancer. In this study, we analyzed compliance with these QIs in a large referral center in the Netherlands. A critical analysis of the QIs that deviated from the targets was performed. Data of all 402 patients, who were surgically treated for cervical cancer with International Federation of Gynaecology and Obstetrics (FIGO) 2009 stage IA–IIA at the Amsterdam University Medical Center from 2007–2016, were retrospectivly analyzed with regard to adherence to the ESGO QIs. Targets set for three out of 15 ESGO QIs were not met. A pre-operative Magnetic Resonance Imaging (MRI) was performed in 92% of patients (target 100%). The percentage of upstaging of clinical stage into a higher pathological stage after surgery was 17.2% (target <10%). The third target that was not met was the minimally required elements in the pathology report. Parametrial length measured in two dimensions, histological grade and extra-nodal extension of lymph node metastasis were reported in respectively 0%, 32% and 42%, whereas the target was ≥90%. In contrast to the three QI targets that were not met, performance with regard to two out of 15 QI was far better than the targets set. This included recurrence rate at 2 years and the percentage of adjuvant (chemo)radiotherapy in (p)T1b1N0. QIs are important to evaluate care. They should be clearly described to ensure they are correctly interpreted. QIs and their targets should be based on solid evidence to ensure that reaching the target results in improvement of quality of care. Although the three QI targets that were not reached in our center are subject to criticism, they are still useful for prospective data collection and quality evaluation.


Cervical cancer; Quality indicator; Surgery

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Constantijne H. Mom,Luc R.C.W. van Lonkhuijzen,Maaike C.G. Bleeker,Guus Fons,Jacobus van der Velden. An analysis of deviation from the ESGO quality indicators for surgical treatment of cervical cancer in a large referral center in the Netherlands. European Journal of Gynaecological Oncology. 2023. 44(6);128-135.


[1] Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2021; 71: 209–249.

[2] Van der Aa M. Cervical cancer in the Netherlands, trends en data from the Netherlands cancer registry. 2023. Available at: (Accessed: 28 April 2023).

[3] Landheer MLEA, Therasse P, van de Velde CJH. The importance of quality assurance in surgical oncology. European Journal of Surgical Oncology. 2002; 28: 571–602.

[4] Cibula D, Planchamp F, Fischerova D, Fotopoulou C, Kohler C, Landoni F, et al. European society of gynaecological oncology quality indicators for surgical treatment of cervical cancer. International Journal of Gynecologic Cancer. 2020; 30: 3–14.

[5] Bonte A, Luyckx A, Wyckmans L, Trinh XB, van Dam PA. Quality indicators for the management of endometrial, cervical and ovarian cancer. European Journal of Surgical Oncology. 2019; 45: 528–537.

[6] Boria F, Chiva L, Chacon E, Zanagnolo V, Fagotti A, Kucukmetin A, et al. SUCCOR quality: validation of ESGO quality indicators for surgical treatment of cervical cancer. International Journal of Gynecological Cancer. 2022; 32: 1236–1243.

[7] Querleu D, Morrow CP. Classification of radical hysterectomy. The Lancet Oncology. 2008; 9: 297–303.

[8] Cibula D, Pötter R, Planchamp F, Avall-Lundqvist E, Fischerova D, Haie Meder C, et al. The European society of gynaecological oncology/European society for radiotherapy and oncology/European society of pathology guidelines for the management of patients with cervical cancer. International Journal of Gynecologic Cancer. 2018; 28: 641–655.

[9] Boria F, Chiva L, Zanagnolo V, Querleu D, Martin-Calvo N, Capilna ME, et al. Radical hysterectomy in early cervical cancer in Europe: characteristics, outcomes and evaluation of ESGO quality indicators. International Journal of Gynecological Cancer. 2021; 31: 1212–1219.

[10] Ding Y, Zhang X, Qiu J, Zhang J, Hua K. Assessment of ESGO quality indicators in cervical cancer surgery: a real-world study in a high-volume Chinese hospital. Frontiers in Oncology. 2022; 12: 802433.

[11] Ponce J, Fernandez-Gonzalez S, Gil-Moreno A, Coronado PJ, De la Rosa J, Nabais H, et al. Risk factors for recurrence after robot-assisted radical hysterectomy for early-stage cervical cancer: a multicenter retrospective study. Cancers. 2020; 12: 3387.

[12] Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a gynecologic oncology group study. Gynecologic Oncology. 1999; 73: 177–183.

[13] van Meurs H, Visser O, Buist MR, ten Kate FJW, van der Velden J. Frequency of pelvic lymph node metastases and parametrial involvement in stage IA2 cervical cancer: a population-based study and literature review. International Journal of Gynecologic Cancer. 2009; 19: 21–26.

[14] Jung W, Park KR, Lee K, Kim K, Lee J, Jeong S, et al. Value of imaging study in predicting pelvic lymph node metastases of uterine cervical cancer. Radiation Oncology Journal. 2017; 35: 340–348.

[15] Scottish Cancer Taskforce—National Cancer Quality Steering Group. Cervical cancer: clinical quality performance indicators. 2018. Available at: (Accessed: 28 April 2023).

[16] Horn L, Hentschel B, Galle D, Bilek K. Extracapsular extension of pelvic lymph node metastases is of prognostic value in carcinoma of the cervix uteri. Gynecologic Oncology. 2008; 108: 63–67.

[17] Metindir J, Bilir Dilek G. Evaluation of prognostic significance in extracapsular spread of pelvic lymph node metastasis in patients with cervical cancer. European Journal of Gynaecological Oncology. 2008; 29: 476–478.

[18] Park KJ, Selinger CI, Alvarado-Cabrero I, Duggan MA, Kiyokawa T, Mills AM, et al. Dataset for the reporting of carcinoma of the cervix: recommendations from the international collaboration on cancer reporting (ICCR). International Journal of Gynecological Pathology. 2022; 41: S64–S89.

[19] Hoffman MS, Cardosi RJ. Intraoperative measurements to determine the extent of radical hysterectomy. Gynecologic Oncology. 2002; 87: 281–286.

[20] Muallem MZ. A new anatomic and staging-oriented classification of radical hysterectomy. Cancers. 2021; 13: 3326.

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